ABSTRACT
Background: Rickettsial infections are re-emerging. In India, they are now being reported from several areas where they were previously unknown. Objectives: The objective of this study was to describe the epidemiology, clinical profile and outcome of serologically-confirmed scrub typhus and spotted fever among children in a tertiary care hospital in Bengaluru. Materials and Methods: Hospitalised children aged <18 years, with clinical features suggestive of rickettsial disease admitted between January 2010 and October 2012 were included prospectively. Diagnosis was based on scrub typhus and spotted fever-specific IgM and IgG by enzyme-linked immunosorbent assay (ELISA). Results: Of 103 children with clinical features suggestive of rickettsial illness, ELISA test confirmed 53 cases for scrub typhus, 23 cases for spotted fever group and 14 with mixed infection. The average age was 7.3 (±3.9) years and 44 (71.0%) children were male. Majority of cases were from Karnataka (50%), Andhra Pradesh (32.3%) and Tamil Nadu (17.7%). Common clinical features included fever (100%, average duration 11 days), nausea and vomiting (44%), rash (36%); eschar was rare. Compared to the ELISA test, Weil-Felix test (OX-K titre of 1:80) had a sensitivity and specificity of 88.7% and 43.9%, respectively. Treatment with chloramphenicol or doxycycline was given to the majority of the children. Complications included meningoencephalitis (28%), shock (10%), retinal vasculitis (10%) and purpura fulminans (7%). Conclusions: These findings suggest that the burden of rickettsial infection among children in India is high, with a substantially high complication rate. Rickettsial-specific ELISA tests can help in early diagnosis and early institution of appropriate treatment that may prevent life-threatening complications.
Subject(s)
Child , Cholecystitis/epidemiology , Humans , India/epidemiology , Typhoid Fever/complicationsABSTRACT
The usefulness of single Widal test in the diagnosis of typhoid fever was investigated. The test was done on 50 normal children, 50 children with non typhoidal fevers and 30 culture proved typhoid cases. Twenty one (70%) and nine (30%) of thirty typhoid fever cases had 'O' and 'H' agglutinin titer levels of more than or equal to 1:160, respectively as compared to only 3 (3%) and to 1 (1%) among controls. These differences were significant (p < 0.001). Twenty two (73.3%) out of thirty typhoid fever cases had either an 'O' or 'H' agglutinin titer of more than or equal to 1:160 as compared to only 3 (3%) among controls. An 'O' agglutinin titer of 1:160 had a specificity of 97%, a sensitivity of 70% and an accuracy of 90%. An 'H' agglutinin in titer of 1:160 was had a specificity of 97%, a sensitivity of 30% and an accuracy of 83.1%. Based on the above analysis, 'O' or 'H' titers of 1:160 or more were indicative of typhoid fever. Similarly, when the 2 titers were considered together, either 'O' or 'H' titers of 1:160 or more were suggestive.
Subject(s)
Agglutination Tests , Case-Control Studies , Child , Humans , Predictive Value of Tests , Reproducibility of Results , Sensitivity and Specificity , Typhoid Fever/bloodABSTRACT
Utilizando-se do referencial teórico clássico da sociologia das profissöes, o autor discute as transformaçöes ocorridas na profissäo dos advogados nos Estados Unidos e as compara com aquelas observadas na Medicina no Brasil. A opçäo metodológica por comparar profissöes diferentes buscou assegurar uma maior isençäo na análise das características de duas profissöes liberais clássicas e näo comparar duas medicinas. Temas como o controle do mercado, a auto-regulamentaçäo profissional, a má prática profissional e a ética säo discutidos à luz do referencial teórico referido, para questionar a situaçäo da profissäo médica no Brasil
Subject(s)
Ethics, Medical , Medicine , Sociology, Medical , Brazil , Ethics, Professional , Liability, LegalABSTRACT
Neste trabalho, refletimos sobre a situacao de hospitalizacao da crianca. Admitimos que esta e uma experiencia estressante, mas que pode ser amenizada pelo favorecimento de certas condicoes, como presenca de familiares, contato com outras criancas, disponibilidade afetiva da equipe, informacao etc. Analisamos problemas como recusa a medicacao ou dificuldade em permitir a realizacao de exames dolorosos e assinalamos a maior sensibilizacao da crianca com doenca cronica ou terminal.Observamos que as criancas costumam expressar suas duvidas e angustias por vias indiretas, ou mesmo por perguntas a alguem da equipe, sendo fundamental estar atento a comunicacao da crianca hospitalizada
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Humans , Male , Female , Affective Symptoms , Child, HospitalizedABSTRACT
Neste trabalho, procuramos pensar a questao da hospitalizacao da crianca pelo lado do familiar, dando especial atencao a maneira como a familia vive este problema.Utilizamos material diretamente expresso pelos familiares ou observacoes realizadas em nosso contato quotidiano, podendo concluir que, em geral, os familiares desejam acompanhar suas criancas, excetuando-se situacoes onde existam graves impedimentos objetivos e (ou) emocionais. Observamos, tambem, que o esclarecimento a familia desempenha importante papel na relacao equipe-familiar, embora, muitas vezes, a familia possa negar uma informacao grave, necessitando de um tempo emocional para elaborar o que foi comunicado. Finalmente, e importante observar que processos emocionais foram desencadeados pela situacao de hospitalizacao, atualizando os antigos conflitos
Subject(s)
Humans , Child, Hospitalized , Professional-Family RelationsABSTRACT
Este trabalho foi escrito a partir das reflexoes de um grupo que se reunia semanalmente para discutir aspectos relativos a internacao de seus pacientes, sendo um primeiro esforco de sistematizacao e supondo dois momentos: o questionamento de aspectos que consideramos muito pregnantes em nossas relacoes com a crianca hospitalizada e seus familiares e o aprofundamento destas questoes a partir de uma compreensao teorica. Procuramos, assim, identificar em aspectos particulares os denominadores comuns do trabalho de uma equipe de saude, detectando vivencias e sentimentos que nao se prenderiam as especificidades desta equipe, mas que seriam quase determinados pelo lidar com a crianca hospitalizada